Safety Management/Hazard Prevention

Introduction:exit sign

A direct care staff person provides care for residents in many ways. As you learned in the last module, knowing a resident’s background helps you to assist the individual to be independent. A direct care staff person also needs to protect the resident from accidents and hazards. This session will help you to learn more about how to create a safe living environment.

The two leading causes of unintentional injury and death for persons over the age of 65 years are fires and falls. However, there are other residents who, because of mental retardation, emotional or physical problems, are at risk for injury from accidents. Most of these accidents are caused by hazards in the environment and are preventable. An important aspect of prevention is to make sure that medications, chemical cleaners and any other poisons are kept locked.

The direct care staff person is responsible for knowing the regulations about fire safety and general safety. In this module you will learn to recognize fire, electrical and fall hazards and steps you can take to keep the environment safe for residents. You will be introduced to safety practices to prevent fires from occurring. Procedures for what you should do if a fire occurs will be described.


How do fires start?

For a fire to start, it needs four things:

  1. Fuel – Something that can burn.
  2. Heat – to ignite the material.
  3. Air – to keep the fire going.
  4. Chemical reaction – fire.

The first three are referred to as the “fire triangle.”

When you keep the first three separate, you prevent the chemical reaction (fire) from happening. For example, a lit cigarette (heat) falls into the trash (fuel) and the presence of oxygen in the air causes a chemical reaction (fire).

Fires are a serious threat to people who need assistance with moving quickly or have difficulty following directions. This is true of many residents of personal care homes. Residents with mental illness or dementia, or who have functional impairments from any cause are at risk for injury. The risk increases dramatically with age. Persons 65 years of age and older are at two to five times greater risk to die in a fire than the rest of the population. What do you think causes these fires? Fires usually start from careless smoking, heating or cooking.

Careless smoking is the leading cause of fire deaths and second leading cause of injury for older persons. Fires from smoking frequently happen in early morning, afternoon or late evening when people are sleeping or relaxing. Just imagine––a person sits down to relax and lights a cigarette, becomes drowsy and falls asleep. The risk increases if a person drinks alcohol or takes medications that cause drowsiness. Fires can start when persons who are smoking are unattended or unsupervised. Sometimes the person forgets to put out the cigarette or doesn’t completely put it out and the cigarette continues to smolder. A resident may never smoke in his/her bedroom. Smoking in rooms where oxygen is being used is also a hazard. Every home is required to have smoking safety procedures and policies. Your on-site orientation will provide you additional information about safe smoking procedures and policies and any designated smoking areas for your facility. Some homes prohibit smoking inside the home or even outside the home.

Cooking is the leading cause of injury from fire and the third leading cause of death. Here are some specific cooking-related dangers:

  • A person leaves a hot stove unattended for just a few seconds to answer the phone or to help someone in another room.
  • Persons wear loose fitting clothing or long flowing sleeves while cooking.
  • A person leaves hot mitts or paper towels near a hot stove and they ignite.
  • The person cooking forgets to turn off appliances.
  • The person leaves pot handles extending over the front of the stove where they can bump into them, causing a serious scalding burn. Turn all pot handles to the side or back of stovetop.

Heating is the second leading cause of fire death and third leading cause of injury. Most of these fires occur in months when the weather is cold and heating devices such as space heaters, fireplaces and wood stoves are used to add extra warmth. Portable space heaters may never be used in personal care homes. Portable space heaters are very dangerous and cause fires. Secure screens and protective guards are required for fireplaces and wood and coal burning stoves. If your facility has any of these heating sources, you will want to keep flammable items, such as newspapers or cleaning fluids, away from the heating source.

Another source of fires is faulty electrical equipment. Electrical appliances are often used in cooking. You may also be using electrical appliances in the process of assisting residents with their activities of daily living. Some safety measures you can take to prevent electrical fires are:

  • Check all electrical appliances for frayed cords or damaged plugs before using.
  • Avoid overloading electrical circuits by plugging in numerous cords.
  • Only use items that have “UL” tag on them.
  • Do not try to repair electrical equipment yourself.
  • If an electrical appliance begins to “smoke,” turn it off, unplug and remove it.
  • Unplug a countertop appliance when the appliance is not in use.

Since oxygen is one of the three things needed for fire to start, the presence of extra oxygen in the facility when persons use oxygen is a special concern. You will want to make sure there is no smoking in areas where oxygen is being used. Matches, lighters, smoking materials and other flammable products like nail polish, alcohol and oils should be removed. Wool and synthetic clothing can create static. Clothing made of cotton is best to eliminate the risk of static and sparking. Electrical equipment like radios, toys and razors, can also create sparks.


What should the direct care staff person do if there is a fire?

If there is a fire in the building where you are now going through this training program, what would you do? Finish reading this sentence? Look around? The right course of action is for you to act quickly and R.A.C.E. to respond to the fire.

The R.A.C.E. response for the direct care staff person is to:

  • Remove any residents or other persons near the fire.
  • Activate the alarm to notify others that there is a fire.
  • Confine the fire by closing doors as you exit the room.
  • Exit. All residents in the home must quickly evacuate outside the building (or in some homes, to a fire safe area inside the home).

All personal care homes are required to have operable smoke detectors or fire alarms to alert you of fires. Some homes may have sprinkler systems. Knowing where this equipment is located is necessary in the event you need to activate an alarm. Look for detectors in the hallways and outside the bedroom doors. You will also want to learn if there are any residents with hearing impairments who are dependent on signaling devices like vibrating beds or strobe lights to warn them of emergencies.


How do you use a fire extinguisher?

Every personal care home is required to have at least one working fire extinguisher on each floor, including the basement and attic. Sometimes the extinguisher will be locked when it causes a safety risk for residents. It is important for you to learn the location of the extinguishers, and how to unlock and use them.

Newer fire extinguishers use the picture/labeling system to designate which types of fires they are to be used on. Older fire extinguishers used the label with colored geometrical shapes with letter designations.

All personal care homes are required to have at least one fire extinguisher in the kitchen.

All fire extinguishers must be checked on a regular basis to make sure that they are fully charged and ready to use in case of an emergency.

Think of the word PASS to learn to use a fire extinguisher:

P - Pull the metal pin on the upper handle.

A - Aim at the base, or the bottom, of the fire or flame.

S - Squeeze the handle while holding the extinguisher up straight.

S - Sweep from side to side while still aiming at the base.

A direct care staff person should not use a fire extinguisher to fight a fire. It should be used only to clear an exit path or put out a fire on a person.


How do you plan for a fire emergency?

The best way is to prepare yourself and the residents for an emergency before it happens.

Whenever you observe any safety hazard, follow the home’s policy for reporting it.

Every personal care home has a fire evacuation plan. During orientation, you will need to learn your facility’s policies and procedures for fire emergencies. Locate the public place where these procedures are posted and bring it to the residents’ attention. Here are some other things you will need to know to help yourself and the residents move quickly to safety:

  • How to contact local fire and emergency services.
  • The location of the exits – there are at least two independent and accessible exits on every floor.
  • The location of the escape routes and how to evacuate the home. These routes must be unlocked and clear at all times.
  • How to assist residents with mobility needs during an evacuation.

Why do we have fire drills? The best way to avoid deaths in a real fire is to Practice, Practice, Practice. If all residents and direct care staff persons know and practice exactly what to do when the fire alarm sounds, safe evaluation in a real fire is likely. Stories from personal care home staff and residents who have survived fires without injury or death always tell of fire drills saving lives. In a real fire seconds count. It is important to respond immediately and evacuate the building quickly.

Unannounced fire drills are held at least once a month. Once every six months the fire drill is held during sleeping hours. Nighttime drills are important since most fire deaths occur while people are sleeping. It takes longer for the resident to wake up and get moving if he/she is asleep. By practicing fire drills during sleeping hours, the resident will be ready to respond in a real fire. Alternate exit routes are used during the drills. When these drills occur, you will need to help residents move as quickly and safely as possible and assist the residents to evacuate the building. Frequent fire drills are important because residents may have missed many of the drills or forgotten the procedure, especially those with memory problems. Staff need a lot of practice with fire procedures so that when emergency strikes, they immediately know their role and act quickly to protect residents.


Slip, trip and fall prevention:

Can you remember a time when you had a bad fall or tripped over something in your path? It happens so fast! Were you able to recover quickly or did it take a while? Falls are the leading cause of injury and death for older people. They are the most common cause of non-fatal injuries and hospital admission for trauma. When an older person falls, his/her ability to function physically can be decreased and he/she may become permanently disabled. This loss of independence can lead to further decline in physical abilities, depression, feelings of helplessness and social isolation.


What are the common causes of slips, trips and falls?

Think about a time when either you or someone you know slipped, tripped or fell. How did it happen? Take a look around the room you are in now. Do you see any hazards that could result in someone tripping, slipping or falling?

Some of the common causes of falls include the following:

  • Frayed carpet and slippery rugs.
  • Loose tiles or lifted edges of floors.
  • Wet floors.
  • Cluttered hallways or paths.
  • Shoes, slippers or socks that are slippery.
  • Ice or snow.
  • Poor lighting, including burnt-out light bulbs.
  • Loose or missing handrails on staircases.
  • Slipping in bathtubs or showers.
  • Trying to get out of bed or a chair without necessary assistance.

Other hazards are unlocked safety brakes on wheelchairs and broken walkers or canes. These are all devices that may be used by older persons to assist them in remaining as independent as possible. The risk of falls increases when older persons take medications that cause drowsiness or dizziness or have physical weakness and walking problems.


What can the direct care staff person do to reduce the risk of slips, trips and falls?

If you think about the causes of slips, trips and falls, you will think of answers to reducing them. For example, if throw rugs cause tripping, remove them and replace them with safer carpeting or non-slip flooring. Let’s look at some additional ways to reduce slips, trips and falls:

  • Use wheelchairs to provide safe mobility.
  • Encourage residents to use grab bars, raised toilet seats, adjustable bed heights and handrails in hallways to help them get up and down and move from one place to another safely.
  • Make sure all cords, including extension cords do not lay where people walk.
  • Remove hall clutter.
  • Check to see that stairways are well lit so that each step, particularly the step edges, can be clearly seen by the residents while going up and down the stairs. The lighting should not produce glare or shadows along the stairway.
  • Use the maximum wattage bulb allowed by the light fixture. If you are uncertain about the recommended wattage, use a 60-watt bulb or lower.
  • Do not store anything on the stairs, even temporarily.
  • Ensure that handrails are sturdy and fastened securely on both sides of the stairway.
  • Help residents remain mobile by encouraging them to do exercises that build up leg muscle (walking, tai chi, etc.). This is one of the best ways to prevent falls.
  • Use rubber mats and slip-proof tub mats inside and outside bathtubs and showers.
  • Be attentive to the resident’s need for assistance to get into or out of bed and in and out of a chair.
  • Keep a night light on in the resident’s room so they can get to the bathroom safely. (Nighttime rising to go to the bathroom is a common time for falls.)

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